, hearing none, item no. 7. >> the clerk: item 7. action item reconciliationofkaisermedicarerate. >> good afternoon, neale kosher. nice to see everyone again. i'm going to walk you through the document labeled kaiser medicare rate final rate for 2014. when we met on june 13th of this year, we stated that the medicare advantage rates for kaiser were preliminary, that we needed to get additional information brought to kaiser. they cooked the final rates and they would let you know at that time. as soon as we knew what they were and then we can talk about how we decide what to do whether they would have to be higher, the rates or lower. we always hope because of the timing and everything comes in better and there is money to be appropriated in some fashion for the cost of the rates. we finalized everything in the system. that is done to be clear on that part. so what happened was kaiser did their magic and got their final numbers and our number we posted at the 14th of june was $346.45. the final number is $344. that saves the city $2.8 million. which is a very good thing. they do

kaiserfraser,using their last names.andkaiserfrazermanufactured cars at the old bomber plant until 1953 when in 1953, they were -- sales had declined and they were consolidated into toledo, ohio. and in that factory then, general motors took it over and needed the factory after losing their hydromatic plant from a fire outside of detroit. they moved here to ypsilanti to manufacture transmissions and then took half the factory and used it as an assembly plant. a general motors story here. we have a kaiser frazer story here which was major auto industries in the last half of the 20th century. hudsons were not manufactured here in ypsilanti. they were manufactured in detroit. we have this hudson dealership that's a very good example of car dealerships in the early part of the 20th century. we used the dealership then to tell the hudson story. we're in the front of our dealership. where the showroom was where you come and look at your car that you were looking to shop and buy. here in our showroom, we have displayed a 1933 terraplane. we're in a hudson dealership. 1933 terraplane was d

at historical democratic reportsfromkaiserandi think i attached late, but it was an attachment and that was waiting for you when you arrived on the demographic reports. these demographic reports came to the same conclusion that the kaiser foundation had trended. >> someone's cellphone is going off. >> sorry, the kaiser membership has trended younger over time. and so i think we are all on the same page. they are now with that in terms of it being a factor that has been included in our renewal and is clear that although the kaiser membership has grown and grown in all areas of young and old membership that over all the age has improved. we have a younger population than we've had in 2009. we also talked quite a bit about the risk study. one of the funding proposals we are considering is risk premiums and an agreement on how to do the risk study to determine the risk of the population. we have agreed on a medical and pharmacy all claim data based risk study that has been initiated and we have the goal of completing that by february of 2014 for the board's review in march and if

demand for consumer goods. they went together and created a companycalledkaiserfrazier.they manufactured cars at the old bomber plant from the end of world war ii until 1953. in 1953, they were -- sales had declined and they were consolidated into ohio. in that factory, general motors took it over and needed a factory after losing their plant from a fire. they moved here to manufacture transmissions and then they took half of the factory and used it as an assembly plant. we have got a general motors story here. we have got a kaiser frazier story here, which is major auto industries in the last half of the 20th century. hudsons were not manufactured here. they were manufactured in detroit. but we have this hudson dealership that is a very good example of car dealerships in the early part of the 20th century. we use the dealership also to tell the story. you come and look at it, your car that you were going to shop and buy. we have display a 1933 plane. we're in the hudson dealership, 1933 was designed and planned by hudson motor car company to compete with ford, general

tomorrow. created a companycalledkaiserfrasierusing their last names. and cakaiser frazier manufactur here until the end of 1953. 1953, they were -- sales had declined. they were consolidated into toledo, ohio. in that factory then general motors took it over and needed a factory after losing their hydromatic plant from a fire in lavonia outside of detroit. they moved here to ypsilanti to manufacture hydromatic transmission, and they took half of the factory and used it as an assembly plant. we've got general motors story here. kaiser frazer story here. major auto streets in the last half of the 20th century. hudsons were not manufactured here in ypsilanti, they were manufactured in detroit. we have a hudson dealership that's a very good example of car dealerships in the early part of the 20th century. we used the dealership then also to tell the hudson story. we're in the front of our dealership where the showroom was, where you come and look at it, at your car that you were looking to shop and buy. here in our showroom, we have displayed a 1933 terra plane. we're in a hudson dealers

the health -- the health commission as well. as we werediscussingkaiserratesand it's greatthatkaiserishere, it was some question that the care management and other issues were protected and could not be revealed because of trade secrets but i'm wondering on different data like that, would you consider that a trade secret? >> explain to me the data again. what is it? >> so as we were discussing kaiser's rates, there were different issues that i believe kaiser rep said they didn't give and we did receive information from kaiser later, and it's basically -- i think it was called integrated care management and many people were talking about how the rates were going up and kaiser was saying that's trade secrets, i believe. >> i think what i'm mostly here to say is you can claim something is protected by as trade secret, but the only way you find out is if anyone information constitutes a trade secret is try it in court. there are -- it's something that's fact specific and so it's jurisdiction and fact specific, so depending on all the ends and outs of this and how they've used it in th

a great priceandkaiserhasa unique model which many people love. there are many that members particularly love. there is where you can do less of this because we arbitrarily decided it needs to be an x personal of the rate which is not the way we should go. we should look at the overall rate. i want you to look at what's been reported already by all hospitals and hospital acquired infections are publically reported by all hospitals. >> is there a particular site for that? >> yeah. i'm not sure whether it's federal or state website. i don't really go look at them. they are just reports. >> i believe it's the website. i heard they are limiting that website. we may ask the board of supervisors to put pressure on the state because the public scrutiny of that data is really important. we'll get back to you on that. >> any other comments? public comment? seeing none, all right. item no. 9. >> the clerk: discussion item question the blue shield's calculation. >> lisa gut be. i'm going to accept set up the questions. one of our unions is looking at the rates and benefits process

have accepted that contribution model. if we are going to ri main competitive,andkaisercompetitive,the unions must accept the contribution models. >> any other comment? any public comment? item 10: dashboard. >> an an alytic managers system. the dashboard system today is a series of on going support of various health plans. today we'll look at our city plan through 2013. we'll be looking at the merging cost and auto utilization for our active and retirees. the majority of the participating city plan are in the retirement program. the numbers look very good for this group of folks. in contrast, the membership has decrease in our active early retiree pools and those that have either catastrophic illness and those with no other options live outside of the blue shield or kaiser service areas. so, what we've done with this particular dashboard is really conducted a deep dive in our areas of concern. so to that end we are not looking at necessity depth of our retirees. our areas will look at the areas of concern in the active city plan as well as our early retiree. in the report con

to have comment -- public comment in a minute. at this point i'llaskkaisertocome up and thank you for being here and for your continuing to work with the city of san francisco in our service system. >> thank you very much farrel and mar. it's a privilege to be here. we're here to today to lend our support and to affirm our commitment to quality transparency and to price transparency. i am -- i'm the manager here in san francisco for kaiser foundation hospital and health plan and i'm accountable for the care delivered to a little of over $192,000 people. 3,000 healthy san francisco 192,000 people. 3,000 healthy san francisco healthy participant and $3,000 health members and for kaiser california we serve 55,000 city and county employees and a little over 2,000 in san francisco. we value our partner and our relationship with the city and county. and we look forward to collaborating on this effort. for many years, kaiser has been involved in sharing successful clinical practices, quality transparency. we know that by doing that, we get the best clinical outcomes for our patien

the1914kaiserreichas a -- military whose victory would have been a disaster. i suggest that western civilization has as much reason to be grateful that the german amibitions were frustrated, despite the appalling cost and even if the outcome of the first clash proved to have a tragic impermanentance because germany fought all over again a generation later, under hitler. i won't detail events in the summer of 1914 but offer a quick proceed. on the 2nd of june, ferdinand, heir to the hungarian throne, was shot dead by a terrorist. the men in charge of austria felt no special sorrow for prince ferdinand. they say in the outrage an ideal pretext for settling accounts with serbia, a cronk cohn -- some army officers provided the weapons and perhaps also the elm tuesday for the assassination plot, although personally i think it's unlikely the belgrade government was involved. one aspect of 1914 seems to our generation incomprehensible. most european nations regarded war not as the supreme horror but as a usable instrument of politics. many interpretations of how the conflict came about are

plans, you will notice that blue shield is at 169andkaiser185.so what does that mean? if you would set uhs is the baseline, you would find if they would make blue shield the baseline, you would expect them to be about 300 admits and kaiser about 280. they exceeded even if they are one. they are above and beyond what you would predict for utilization. now as far as the average, as you remember, uhs is a length of time of average length of stachlt -- stay. it's 6.5. it far exceeds the norm for northern california, in the sense that it's usually expected to see it under 5. we did want to point out but just in passing because we don't know the amen of the maternity for individuals. this was surprising the age is 48 so you would expect higher risk pregnancies which means longer days of stay. we don't know the age of the people that had the babies. we can't say much. again, looking at heche which is what you would expect having admits in 3 of the four last quarters. their average stay is under one day.1 day. moving on to page 9, what is the total cost per day. it's 42 percent per year.

of the best german ones see the1914kaiserreichas a militarized autocracy his victory would have been a disaster. i suggest that western civilization, almost as much reason to be grateful that the german ambitions were for stated in 1918 as in 1945 despite the appalling cost can even if the outcome of the first clash proved how the tragic impermanence because germany is time under hitler got to the fourth all over again a generation later. i will not tonight detailed events of the summer of 1914, but i will offer a quick prayer. the archduke franz ferdinand, wrote to the austria--ton variant thereof was shot dead by a young hostage -- austrian-serb terrorists. no special sorrow for funds for an animated slight, but what they saw in the average, an ideal pretext for settling accounts with serbia, a politically troublesome little neighbor whose leaders in cited their own minorities to results. some serbian army officers and provided the weapons and households for the emperors of the assassination, although personally and think it is unlikely that the belgrade government was involved. on

. >> i got stitched up many timesatkaiserhospital. my son was born there. >> thank you for being here. >> excuse me. thank you, sir. we'll have public comment in a minute. i want to thank anyone who did come. those speakers, i think, we'll have concluding comments, but we'll open up to public comment. everyone will have two minutes. i have a few speaker cards and there's more. larry brad shau and brook. please, anyone want to speak in public comment and everyone will have two minutes to speak. >> is this working? >> sir, sir, the podium will work, go ahead. >> this is -- [inaudible]. stand still is a body. stop it at a good point where it needs to be stem too. [inaudible]. laws and competitions and unless there's market making and market up and down and competitions. point number two, price structure. difficulties allies for price paid for construction. third point, the way and rules for spending in terms of choices. all mutual benefits [inaudible]. one day of opening or one day of closing. one day of promoting and one way of cutting short. one day of live and one day of ki

mixes of -- if something cost more and we've talkedwithkaiserandi'm sure will address the integrated cost management that they plague in their services and i spoke with them and i appreciate them to talk about what happened this summer, allocate that to the cost of a knee replacement. it should be fair to get services that you provide that affect the cost of a knee replacement. it's not just the knee replacement, but it's the nurses that take care of you and the followup care. what's fair is fair, but i imagine that doesn't seem to me that cuts across saying, we should be able to -- we should share that information so people can have choices. >> i think you make good points. i want to go back to the point you made about medicaid and medicare. all hospitals have that same issue but they don't have all the same share. you can have pockets in your city where there's vulnerable populations or elderly population where the hospital has a share of the care and that is the overall expenses. >> what i really worry about is that people have the lower cost or the lower share of the med-cal

resolving some of these issues. president mar. >> as we were discussingthekaiserservicesgoing on. we brought it to the board level for further discussion and this was some revelation of that data, but kaiser systems wasn't divulgeable because of a gag on ready or a trade system that was being disclosed. it could go from the patients to the health board to the board of supervisors, where do you think is the protected information where people could understand it and it doesn't seem to be protected as a trade secret? >> i think there's different levels of where you can offer that disclosure. certainly in the kaiser instance, at the level at the board of supervisors and hsf in making decisions about what kind of carrier purchasing accident i think transparency is great to help you decide how much you're going to pay. there's ordinances that i have to make sure to insure that the board of supervisors can see that. it's important to realize that there's different claims. something protected by a contract clause that's separate from the trade secret argument. if you're bound by a non dis

:kaiser's inpatientpediatric facility here in hayward closed at mh means chile near here who need to be hospitalized must now go to oakland. the transition was said to be smooth. there were no patients at the facilities so no patients needed to be transferred. the facility averaged four children a day. kaiser said closing the hayward unit will offer a higher level of care. the 21 of the 22 nurses that worked here had been re-assigned, one retired. many of them are still upset about the closure. they say they're concerned about the patients who live near here. >> these people are going to be evaluated in the emergency room. they're going to be too sick at that time and try to stabilize them, and then they have to try transporting them to a facility that has pediatric care. that could take from ten two to six to eight hours. >> we recognize the change in location and we know families want the best for their children, and the best care for children is to be treated in a pediatric specialty center such as kaiser oakland, and this is supported by clinicianses at the children's hospital

and the system has not been set up to provide this information. >> can i ask you aside from and ithinkkaiserisdifferent, but in models like this, are you seeing this trend, the red shading across all plans? >> good question. i actually printed out 20 of these and gave it to my class and analyzed them. all of them had a cost like this. it's the individual market and not the employed market but if you had to guess, i'm going to guess that this model is going to creep into the employer market and so we're going to see within a couple of years a lot of red lines on coverage for employees provided by their employer. there's a reason for this. this lowers premium. all these red things lower premiums because people useless services when they have to pay. the red expertment shows that. if the user is paying the health plan doesn't have to. we're going to see more of these in employer based plans because the employer based plans are paying for those rising prices that i showed you earlier and that really is the elephant in the room. the under lined prices in health care are going up and insur

production in 195, they cleared the plant out and in 1947 it was purchased bythekaiserfrasercompany. they used the plant both for their automobiles. roughly 800,000 automobiles here. kaiser frasers, henry gray. as i said, about 8,000 automobiles were built. also most people win of the b-24 bomber plant and the b-24s that were built here. very few people know we had c-119 flying boxcars built here. roughly 200 were built in the early 1950s. after kaiser fraser was done with the automobiles and their aircraft production, general motors bought the plant. they lost one of their transmission facilities to a fire and they saw this plant. it was empty at the time they purchased it. ever since then until 2010 when it became vacant after the general motors bankruptcy. right now if you look inside the facility there is not much in there. there is a lot of the manufacturing equipment left from general motors on the floor that's slowly being cleared out. once it is cleared out and the power is restored to it again, you can see that it looks just like it did in 1942. this end of the building was

at the facilities so no patients needed to be transferred. the facility averaged four children aday.kaisersaidclosing the hayward unit will offer a higher level of care. the 21 of the 22 nurses that worked here had been re-assigned, one retired. many of them are still upset about the closure. they say they're concerned about the patients who live near here. >> these people are going to be evaluated in the emergency room. they're going to be too sick at that time and try to stabilize them, and then they have to try transporting them to a facility that has pediatric care. that could take from ten two to six to eight hours. >> we recognize the change in location and we know families want the best for their children, and the best care for children is to be treated in a pediatric specialty center such as kaiser oakland, and this is supported by clinicianses at the children's hospitals of oakland, support what we're doing here. reporter: kaiser are outpatient facility here in hayward well rye main open. kaiser says outpatient services make up more than 99% of the care children receive. live in hayw

series on the affordable care act in conjunctionwithkaiserhealthnews focuses on what is happening with the insurance plans that are being canceled. this is 45 minutes. >> on this segment of the "washington journal", we have been taking a look at the implementation of the four book act with the help of reporters from kaiser health news and julie appleby is back to discuss the reason why some individuals have seen their plans canceled by providers as a lot the law has gone into effect. it has become a hot topic and enjoy appleby has talked about the wall that kids have played and why are some receiving cancellation notices. >> guest: these are people who buy their coverage because they don't get coverage through their jobs. an increasing number don't get health insurance, many farmers in turn farmers by their own. that is who this affects and many of those are getting notices saying that their current policy will be discontinued by the end of the year and then they will have to enroll in the new policy and that is because many of these policies don't meet the requirements of the aff

with bomber production, 1975 they cleared the plant out and in 1947 it was performed bythekaiserfraziercompany. kaiser frazier used the plant both for the automobiles with 800,000 automobiles here. henry js and they said about 800,000 were built, but also most people know of the b 24 bomber plant. they have c 119 box cars here. roughly 200 of them built here in the early 1950s. general motors lot of to a fire and saw the plant was empty at the time they performed it and owned it since then in 2010 when it became vacant after the bankruptcy. right now if you look inside the facility, there is not much in there. there was a lot of the manufacturing equipment left from general motors on the floor. this end of the building is never restored. the other end was restored a number of years ago and modernized by general motors. this end hasn't. the original plant was 3.5 million square feet. now it is 5 million square feet. we intend to save about 175,000 square feet. it really is a very insignificant piece of the plant. as they said early, it represents the most significant piece of democracy

on the affordable care act in conjunctionwithkaiserhealthnews focuses on what's happening with the insurance plans that are being canceled. this is 45 minutes. >> host: on mondays in this segment of "washington journal" we have been looking at the implementation of the affordable care act with the help of reporters from kaiser health news. this week julie appleby is back to discuss the reason why some individuals have seen their plans canceled by providers as the law has gone into effect. it's become a hot topic on capitol hill among some talking heads but said the right stay away from the politics and discuss the mechanics at play here. why are some people receiving cancellation notices? >> guest: these are people who buy their own coverage because they don't get it through their jobs. these are folks folks who aren't small business owners. they are self-employed. an increasing number of contract workers by their own. many farmers by their own so there is an estimate of 5% of americans who buy their own coverage. that is who this affects and many of them are getting these notices. we don't

36.3 percent higher than blue shield and 37 percent higherthankaiseronthe risk adjustment basis. >> the overall decrease since q 12011, that's the high point. you could have picked any other point and they could have been increased if they could have picked q 2, 2010? >> yeah. but if you would draw a line particularly since quarter 2009. it has been pretty stable. yes, you are right but we did have a dry point to reflect a change in population as well as a change in activity to justify the cost. >> okay. thank you. >> on page 20, the city plan per thousand has decreased 10 percent since 2 years ago. again, that was the high point that we picked. what we are doing if you will looking at the 96 per thousand kaiser 464 at the in point at 62.7. if you noticed as i mentioned earlier, the city plan is not that different in age and male female distribution. so you will notice that the factor one is much closer at 93 percent. you would not expect to see much changes. if you notice the average length of stay is at 5.9. there is about 1.75 spread between high and low and the blue line of

. >>> there are new developments in the labor disputebetweenkaiseranditsnurses.kaisersaysall of the 22 nurses have been guaranteed a job at another location when they close this weekend. the nurses say they plan to picket on thursday to protest the closure. they say their dispute isn't just about jobs. >>> first responders are performing emergency drills in preparation for real world problems once the fourth bore of the caldecot tunnel opens. ktvu's tom vacar joins us with the critical listen crews learned today. >> reporter: we are down to the final crucial tests that are needed to convince the fire marshal this tunnel is indeed ready to open. in one drill this afternoon a car wreck was also programmed to be a fire. smoke grenades and all. responding crews had to deal with the smoke but the very real winds generated by the 19 jet fans designed to restore fresh air and visibility. >> this is a big, big improvement safety wise. >> reporter: these tests will know all week and are absolutely necessary to open the tunnel. >> real emergency that we have no issues, rescuing people, or communication

at the 96 perthousandkaiser464at the in point at 62.7. if you noticed as i mentioned earlier, the city plan is not that different in age and male female distribution. so you will notice that the factor one is much closer at 93 percent. you would not expect to see much changes. if you notice the average length of stay is at 5.9. there is about 1.75 spread between high and low and the blue line of skilled nursing is the most variable of them all of moving on to the cost per day, what you will notice is the current inpatient cost per day is about 62.43. it's an annual cost of 2.5 years. this is not unexpected and quite reasonable trend for this period of time. moving on to page 23. there is nothing as you look at the graph and you will see it pretty flat. the only thing to draw out here is that the growth is about 1.3 percent. there is a slight growth in er rate of 4.6 percent and surgical cost and yet nothing above trend. lastly looking at the procedures per thousand, again, we have the issue of the other 21,000 of the 33778 are other. and we have to work with uhc to see what goes into t

kaiserheadedoff with medical supplies and food. >> i have family in manila. and they were lucky enough to escape the destruction. but they have been extremely supportive and in fact, my husband is helping me to coordinate this mission. >> the group will be in the philippines for one month and another kaiser team will head in to relieve them. >>> service employees international union held a fundraiser for the victims in daley city today. >>> all the help is certainly needed. international aid efforts are finally reaching more typhoon survivors in the philippines. helicopters from a u.s. carrier air lifted tons of cargo, food, water, medicine, and blankets. the united nations have lots of teams on the ground there. the death toll is 3,600. nearly 1200 people are still missing. >>> highway 116 in petaluma is not expected to reopen until tomorrow morning because of a crash this afternoon. two cars collided gyring one of the drivers around 4:00 p.m. the crash brought down a fire line and sparked a fire. the chp expects highway 116 at adobe road to reopen at 5:00 a.m. tomorrow. drivers shoul

are on their way to the area. a team offourkaiserpermanentedoctors, nurses and technicians left from sfo last night. the volunteers say they are basically flying into the unknown. >> the communication is very poor coming out of the most affected areas. so we've heard very little. but we have heard that there's a lot of medical need and there's a lot of need for medical supplies. >> they will set up a medical clinic. other teams from kaiser permanente will be leaving in the next few weeks. >>> happening today the national federation of filipino american associations will collect canned food, clothing, toiletries and other relief supplies for the victims. you see the information there. the event take place starting at 3:30 this afternoon at san jose's north side community center on north sixth street. cash donations will also be accepted by the red cross. abc7 news is hosting a fundraiser to help typhoon victims tomorrow. you will be able to make donations to the red cross relief fund through a live hotline from 11:00 a.m. to 11:35 p.m. we hope you will be able to contribute. we will have all t

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